Category Archives: Suicide Assessment and Intervention

On the Road to Billings . . . and Well-Being . . . and Happiness

Baby Laugh

Tonight I have the honor of offering a public lecture in Billings. Situated as a part of a series of community suicide-related talks, my title is “Psychological Well-Being and the Pursuit of Happiness.” I suspect somewhere between 3 and 30 people will be in attendance. Although I’m hoping for 30, I’m realistically assuming that Rita and the program’s host will show. Counting me, that makes three!

To help get attendance over 3, someone suggested I edit this post to include the time and location. I’m on at 7pm till 8:30pm on the second floor of the MSU-B library, room 231. Hope to see you there.

Below, I’m pasting the handout for tonight. Being in the green lane, I’m trying to save paper and make these products available online. Here you go!

Psychological Well-Being and the Pursuit of Happiness

John Sommers-Flanagan, Ph.D.

Following is a summary of key points for John Sommers-Flanagan’s presentation for the Big Sky Youth Empowerment Program and Montana Social Scientists, LLC, Billings, MT – November 7, 2019

Introduction: Happiness can run very fast. So, let’s chase well-being instead

  1. The Many Roads to Well-Being. You can find well-being on emotional, mental, social, physical, spiritual/cultural, behavioral, and environmental roadways.
  2. It’s Natural, but not Helpful, to do the Opposite of What Creates Well-Being. If we want to catch well-being, we need to actively plan and pursue it.
  3. The Pennebaker Studies. Writing or talking about deeper emotions and thoughts will make you healthier (better immune functioning) and happier. Choking off our emotions is inadvisable.
  4. The Cherries Story. It’s not what happens to us . . . but what we think about what happens to us . . . that increases or decreases our misery. Focusing on your good qualities can be difficult, but doing so helps build a strong foundation.
  5. Savoring. Use the power of your mind to extend and expand positive experiences.
  6. Why Children (and Adults) Misbehave. When people feel a deep sense of belonging and socially useful, the need to misbehave and feelings of suicide diminish.
  7. Exercise is the Solution (No matter the question). Exercise reduces depression in youth and offsets the genetic predisposition toward depression in adults. You can stretch or lift or do cardio, but get moving!
  8. Holding Hands and Hugging is a Chemical Gift (or not). Consent, timing, and desirable companionship are foundational to whether touch contributes to health.
  9. If You Can’t Catch Happiness or Well-Being, Start Chasing Meaning. Regular involvement in spiritual, cultural, religious, or social justice groups will feel so good that you might experience happiness and well-being along the way.
  10. Remember gratitude. All too often we forget to notice and express gratitude. Put it on your planner; both you and the person who receives your gratitude will thank you for it.

 ****************************************************

John Sommers-Flanagan is a Professor of Counseling at the University of Montana. For more information, go to his blog at johnsommersflanagan.com. John is solely responsible for the content of this handout. Good luck in your pursuit of wellness.

A Sneak Peek at the Suicide Assessment and Treatment Planning Workshop Coming to Billings on November 8

IMG-1852

Anybody wondering what’s new in suicide assessment and treatment?

If so, come listen to any or all of a very nice suicide prevention/intervention line-up on November 7 and 8 on the campus of Montana State University in Billings. Here’s a news link with detailed info: https://billingsgazette.com/news/local/let-s-talk-montana-suicide-prevention-workshops-coming-to-msub/article_9a6f04ff-376f-56b8-a6a8-9a0160ba1cbb.html

For my part, I’m presenting the latest iteration of the suicide assessment and treatment model Rita and I have been working on for the past couple years. To help make suicide assessment and treatment planning easier, we’ve started using six common sense life domains to organize, understand, and apply specific assessment and intervention tools.

Another unique component of our model is an emphasis on client strengths and wellness. Obviously, in the context of suicide, it’s impossible (and wrong) to ignore clients’ emotional pain and suffering. However, we also think it’s possible (and right) to intermittently recognize, nurture, and focus on clients’ strengths, well-being, and goals.

What follows is a sneak peek at what I’ll be covering on Friday, November 8.

Suicide Interventions and Treatment Planning: Foundational Principles

Two essential principles that cut across all modern evidence-based protocols and evidence-based interventions form the foundation of all contemporary suicide assessment and treatment models:

  • Collaboration – Working in partnership with clients
  • Compassion – Emotional attunement without judgment

Collaborative practitioners work with clients, not on clients. Clients experiencing suicidal thoughts and impulses typically know their struggles from the inside out. Their self-knowledge makes them an invaluable resource. Carl Rogers (1961) put it this way,

It is the client who knows what hurts, what directions to go, what problems are crucial, what experiences have been deeply buried. It began to occur to me that unless I had a need to demonstrate my own cleverness and learning, I would do better to rely upon the client for the direction of movement in the process. (p. 11)

Compassionate practitioners resonate with client emotions and engage in respectful and gentle emotional exploration. Although compassion involves an empathic emotional response, it also includes tuning into and respecting client cognitions, beliefs, and experiences. For example, some clients who are suicidal feel spiritually or culturally bereft or disconnected. Regardless of their own beliefs and cultural values, compassionate counselors show empathy for their clients’ particular spiritual or cultural distress.

Clients who are or who become suicidal are often observant, sensitive, and intelligent. If they feel you’re judging them, they’re likely to experience a relationship rupture (Safran, Muran, & Eubanks-Carter, 2011). When ruptures occur, clients typically become less open, less engaged, and less honest about their suicidal thoughts and impulses. They also may become angry, aggressive, and critical of your efforts to be of help. In both cases, relational ruptures signal a need to work on mending the therapeutic relationship.

[For a helpful meta-analysis with recommendations on repairing ruptures, check out this article from the Safran lab: http://www.safranlab.net/uploads/7/6/4/6/7646935/repairing_alliance_ruptures._psychotherapy_2011.pdf%5D

The Six Life Domains

Working with clients who are suicidal can be overwhelming. To help organize and streamline the assessment and treatment planning process, it’s helpful to consider six distinct, but overlapping life domains. These domains provide a holistic description of human functioning. When clients experience suicidal thoughts and impulses, you can be sure the suicidal state will manifest through one or more of these six domains (i.e., emotions, cognitions, interpersonal, physical, spiritual/cultural, and behavioral; see below for a brief description of the six domains). All case examples and content in the workshop use these six domains to focus and organize client problems, goals/strengths, and interventions.

Suicidality as Manifest through Six Life Domains             

The Emotional Domain. A driving force in the suicidal state is excruciating emotional distress. Shneidman called this “psychache” and toward the end of his career concluded: “Suicide is caused by psychache” (1993, p. 53). Extreme distress is experienced subjectively. This is one reason there are so many different suicide risk factors. When a specific experience triggers excruciating distress for a given individual (e.g., unemployment, insomnia, etc.), it may increase suicide risk. Reducing emotional distress and facilitating positive emotional experiences is usually goal #1 in your treatment plan. Treatment plans often target general distress as well as specific and problematic emotions like (a) sadness, (b) shame, (c) fear/anxiety, and (d) guilt/regret.
The Cognitive Domain. Suicidal distress interferes with cognitive functioning. The resulting constricted thinking impairs problem-solving and creativity. The emotional distress and depressed mood associated with suicidality decreases the ability to think of or value alternatives to suicide. Several other cognitive variables are also linked to suicidality, including hopelessness and self-hatred. Most treatment plans will include collaborative problem-solving, and gentle challenging of maladaptive thoughts. Specific interventions may be employed to support client problem-solving, increase client hopefulness, and decrease client self-hatred.
The Interpersonal Domain. Hundreds of studies link social problems to suicidality, suicide attempts, and suicide deaths. Joiner (2005) identified two interpersonal problems that are deeply linked to suicide: thwarted belongingness and perceived burdensomeness. Many risk factors (e.g., recent romantic break-up, family rejection of sexuality, health conditions that cause people to feel like a burden) can exacerbate thwarted belongingness and cause people to perceive themselves as a social burden. Improving interpersonal relationships is often a key part of treatment planning.
The Physical/Biogenetic Domain. Physiological factors can contribute to suicide risk. In particular, researchers have recently focused on agitation or physiological arousal; these physical states tend to push individuals toward suicidal action. Additionally, chronic illness or pain, insomnia, and other disturbing health situations (including addictions) contribute to suicide, especially when accompanied by hopelessness. When present, physical conditions and biogenetic predispositions should be integrated into suicide prevention, treatment planning, and risk management.
The Spiritual/Cultural Domain. Meaningful life experiences can be a protective influence against suicide. No doubt, a wide range of cultural or religious pressures, spiritual/religious exile, or other factors can decrease an individual’s sense of meaning and can contribute to suicidal thoughts and behaviors. Including spiritual or meaning-focused components in a treatment plan can improve outcomes, especially among clients who hold deep spiritual and cultural values.
The Behavioral Domain. All of the preceding life domains can contribute to suicide, but suicide doesn’t occur unless individuals act on suicidal thoughts and impulses. The behavioral domain focuses on suicide intentions and active suicide planning. When clients actively plan or rehearse suicide, they may be doing so to overcome natural fears and aversions to physical pain and death; natural fears and aversions stop many people from suicide. Joiner (2005) and Klonsky and May (2015) have written about how desensitization to physical pain and to ideas of death move people toward suicidal action. Several factors increase risk in this domain and may be relevant to treatment planning, (a) availability of lethal means (especially firearms), (b) using substances for emotional/physical numbing, and (c) repeated suicide rehearsal (e.g., increased cutting behaviors).

*Note: These domains will always overlap, but they can prove helpful as you collaboratively identify problem areas and goals with your client.

If you’re interested in learning more about this suicide assessment and treatment planning model, I hope to see you in Billings on November 8!

 

 

 

Happy Afternoon at ACES in Seattle: Now, Let’s Talk About Suicide Assessment and Treatment Planning

IMG-4449

In a few minutes, along with Kelley McHugh, I’ll be doing my second ACES presentation today. This one is titled, “A New Model for Teaching and Learning about Suicide Assessment and Intervention.” Hana Meshesha was scheduled to join in the fun, but she wasn’t able to come today.

Along with our other doc students, Kelley and Hana are fabulous, focused, smart, and they contribute to my learning.

In the following powerpoints, you’ll see how Kelley, Hana, and I are thinking about how counseling students and professionals should be trained in suicide assessment and intervention. As always, we’re interested in your feedback. Here’s a link to the ppts: ACES Suicide Seattle 2019 Final

And here are a couple suicide assessment/treatment journal articles that might be helpful: Conversations About Suicide by JSF 2018 and SF and Shaw Suicide 2017

On the Road from Suicide to Happiness: Please Send Directions!

IMG-5436

Buddhists often say that life is suffering. Some days, for many of us, that feels about right.

But on other days, the inverse also rings true. Life is joy. Joy is the dialectical sunshine that intermittently breaks through clouds of suffering to interrupt our melancholy.

Don’t worry. Even though there’s currently a September Winter Storm Warning happening in Montana, I’m not going all weather on you. Besides, there’s not much I love more than clouds, rain, and winter storms. Also, to be fair, Buddha and the Buddhists recognized long ago that there’s a road we can take to get away from storms of suffering.

Maybe it’s my penchant for bad weather that’s drawn me, for the past two years, deeply into the professional monsoon of clinical depression, suicide assessment, and suicide interventions. What’s odd about that is that I don’t believe that depression or suicidality should be as pathologized as they have been. I’m a proponent of the right to die. I also find light and hope in the existential perspective that encourages us to embrace and integrate our darker, depressive sides, so we can emerge more whole and, as the existentialist Kirk Schneider likes to say, experience a Rediscovery of Awe.

For the past two years, focusing on suicide has felt very important. Our society isn’t very good at discussing suicide in an open and balanced way. All too often, suicide gets inaccurately conflated with illness or shame or moral weakness. These inaccuracies have inspired me to talk openly about suicide whenever given the opportunity.

But, to be honest, talking and writing about suicide—even from a professional perspective—isn’t all that fun. Those who know me know how much I like to tell funny stories. For years, I’ve had an untreated addiction to showing Far Side and Calvin and Hobbes cartoons during presentations. You wouldn’t believe how hard it is to find suicide cartoons that are workshop-worthy. When I show my cartoon with the white rat in the cage hanging itself and the lab scientist saying, “Looks like discouraging data on the antidepressant” if there’s any laughter it’s a painful and strained laughter, at best.

I do have one amazing depression cartoon; it’s a Gary Larson Far Side scene of a sad looking man on a bed in a messy room with the caption, “The bluebird of happiness long absent from his life, Ned is visited by the Chicken of Depression.”

But let me get out of my addiction and to the point. In my work on suicide prevention and intervention, I’ve slowly realized that we need to paddle upstream. I won’t stop talking about depression and suicide, but I want to more explicitly acknowledge that disabling depression and tragic suicides are often the inverse of well-being or happiness turned upside down. To address this effort at integration, I’m preparing materials to teach and present on the science of happiness. This is where I need your help. Yes, please send more suicide and depression cartoons, but even more importantly, send me happiness cartoons! I’m expanding my focus, and getting ready to spend more time talking about how we can all live happier and more meaningful lives. One way I’m doing this is by teaching a new “Happiness” course this spring at the University of Montana.

As background, I should let you know that I’m familiar with the Yale Happiness Class, the Penn Positive Psychology Center, and other popular resources. Although I’ll use this mainstream material, I want to do something different.

Here’s how you can help.

I’m looking for lecture material and happiness lab activities. Examples include,

Lecture content

  • Video clips
  • Songs with meaning
  • Demonstration activities
  • Quirky/meaningful stories

Lab activities

  • 30-60 minute specific experiential activities that can deepen student learning
  • Evidence-based experiential activities that demonstrate how to counter depression or embrace meaning

Because I’ll be delivering the course to undergraduates, as you contemplate sending me a map with directions to happiness, please put on your 19-year-old hat and help me find destinations with academic substance, but that will still appeal to the college-age generation.

As always, thanks for reading. I wish you a weekend (and life) filled (at least intermittently) with the sort of happiness and joy that’s palpable enough to sustain you until the next bluebird of happiness lands on your shoulder. And if you live in Montana, be sure to stay warm in the winter storm.

John S-F

When Happiness Ran Away: Thoughts on Suicide and the Pursuit of Happiness

Elephant

Several days prior to driving across the state to a party with her family, a friend met up with Rita and me. We talked about happiness. She said she liked the word contentment, along with the image of hanging out in a recliner after a day of meaningful work.

Following the party, she wrote me an email, sharing, rather cryptically, that her party planning turned out just okay, because,

“Sigh. Some days happiness runs so fast!”

I loved her image of chasing happiness even more than the image of her reclining in contentment.

As it turns out, being naturally fleet, happiness prefers not being caught. Because happiness is in amazing shape, if you chase it, it will outrun you. Happiness never gets tired, but usually, before too long, it gets tired of you.

In the U.S., we’ve got an unhealthy preoccupation with happiness, as if it were an end-state we can eventually catch and convince to live with us. But happiness doesn’t believe in marriage—or even in shacking up. Happiness has commitment issues. Just as soon as you start thinking happiness might be around to stay, happiness suddenly disappears in the night.

Maybe our preoccupation with happiness is related to that revered line in the U.S. Declaration of Independence about the right to life, liberty, and the pursuit of happiness. Grandiose words indeed, because, at this point in the history of time, I’m not so sure any of us have an inalienable right to any of those three wondrous ideals.

But don’t let my pessimism get you down. Even though I’m not all that keen on pursuing happiness, I believe (a) once we’ve defined happiness appropriately, and (b) once we realize that instead of happiness, we should be pursuing meaningfulness, then, (c) ironically or paradoxically or dialectically, happiness will sneak back into our lives, sometimes landing on our shoulders like a delicate butterfly and other times trumpeting like a magnificent elephant.

Another reason not to feel down is because next Tuesday, October 1, I’ll be in Red Lodge, Montana as the speaker of the month for the Red Lodge Forum for Provocative Issues.

How cool is that?

My Red Lodge Forum presentation is: Suicide, Suicide Prevention, and the Pursuit of Happiness.

Just in case you’re passing through Red Lodge or happen to know someone in the general vicinity, below I’ve pasted the promotional email for the event. Please come if you can. There will be a fancy dinner, which inevitably involves a full stomach, which, even though I’m talking about suicide, might provide you with a twitch or two of happiness.

Here’s the promo:

From: Red Lodge Forum <redlodgemtforum@gmail.com>
Sent: Sunday, September 22, 2019 2:13 PM
To: ‘Red Lodge Forum’ <redlodgemtforum@gmail.com>
Subject: Tuesday October 1st Forum for Provocative Issues. Dinner reservations open

Forum for Provocative Issues

Suicide, Suicide Prevention, and the Pursuit of Happiness

Tuesday, October 1

PROGRAM

Beginning in 2005, death by suicide in the U.S. began rising, and despite vigorous national and local suicide prevention efforts, suicide rates have continued rising for 13 consecutive years. Depending on which metrics you prefer, suicide rates are up from somewhere between 33% and 61% from their levels at the turn of the century.

In Montana, we have the dubious distinction of the highest per-capita suicide rates in the U.S., at about 29.0 per 100,000 Montanans. Why? What is so peculiar about Montana?

But suicide is about much more than numbers. Join us on Tuesday, October 1 when Distinguished Professor at the University of Montana, John Sommers-Flanagan talks about what contributes to suicide, why Montana’s rate is so high, what’s wrong with suicide prevention efforts, and how we should talk with friends about suicide. Although suicide is a difficult, emotionally charged, subject, John will explore emotions that can create and sustain happiness.

FORUM CATERER CHANGE

In the next section, you will notice our caterer has changed. Martha Young, who has faithfully served our delicious meals for eight years, first at Café Regis, and more recently at the Senior Center, is unable to caterer our October meal. Prerogative Kitchen, an outstanding local restaurant,  has agreed to stand in.

DINNER RESERVATIONS NOW OPEN

Dinner at the Red Lodge Senior Center (13th St and Word Ave) will start at 5:30 pm and our program shortly after 6. If you plan to have dinner, email RedlodgeMtForum@gmail.com (no text or calls) with:

  • your reservation request,
  • your general meal choice (meat/fish, veggie, non-gluten), and
  • your cell number

If you don’t receive an email confirmation of your request promptly, please resubmit it. When I know specific dinner choices later this week, I will ask you to confirm your choice.

If you plan to attend the forum but not eat, come around six but donate $5 to help defray room rental and other expenses.

The price for this  dinner is $18. Please bring a check written prior to your arrival to Prerogative Kitchen for $18 per person. It will reduce traffic at the door, seat everyone faster, and make our cashier’s job easier.  If you want to leave an additional gratuity, simply leave cash on the table. Do not include gratuities in your check.

If you have friends who are interested in attending the forum, feel free to forward this message.

HAS YOUR EMAIL CHANGED?

If you change your email address and want to continue receiving forum notices, remember to send the change to RedlodgeMtForum@gmail.com.

INFORMATION ABOUT UPCOMING AND PAST FORUMS

For quick access to all news about upcoming and past programs, become a member of our Facebook group page, which supports FPI programs.  To access the page, simply search “Forum for Provocative Issues.”  This is an open group, but we carefully screen applicants to avoid potential problems by asking three simple questions.

USE OF FORUM EMAILS

I never share the emails of forum members. However, I have on occasion sent information about community issues and events that I think members will find valuable.

FORUM SUGGESTIONS

If you have an idea for a forum, email it to RedlodgeMtForum@gmail.com.

FUTURE FORUMS

The dates for our 2019/2020 season follow. Mark them on your calendar now to avoid conflicts.

  • November 5, The Future of Nuclear Energy, Redfoot
  • December 10, Japanese American Internment Camp Conditions in WWII, Russell
  • January 14, Fighting Fires, Saving Homes, Trapp
  • February 4, Apollo 8 and the Race for Space, Dragon
  • March 3, Subject TBD, Darby
  • April 7, Dark Money in Politics, Adams
  • May 5, Genetics and the Future of the Human Race, Gunn